|
HC SODIUM URINE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: IEHP Medi-Cal |
$6.74
|
| Rate for Payer: IEHP Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SODIUM URINE
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SODIUM URINE 24 HOURS
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: IEHP Medi-Cal |
$6.74
|
| Rate for Payer: IEHP Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SODIUM URINE 24 HOURS
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SODIUM URINE RANDOM
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SODIUM URINE RANDOM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: IEHP Medi-Cal |
$6.74
|
| Rate for Payer: IEHP Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.03
|
| Rate for Payer: Heritage Provider Network Senior |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.47
|
| Rate for Payer: Blue Shield of California EPN |
$80.89
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.26
|
| Rate for Payer: Heritage Provider Network Senior |
$40.26
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: IEHP Medi-Cal |
$18.36
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.03
|
| Rate for Payer: Heritage Provider Network Senior |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.47
|
| Rate for Payer: Blue Shield of California EPN |
$80.89
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.26
|
| Rate for Payer: Heritage Provider Network Senior |
$40.26
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: IEHP Medi-Cal |
$18.36
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.03
|
| Rate for Payer: Heritage Provider Network Senior |
$216.03
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.76
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.27
|
| Rate for Payer: Heritage Provider Network Senior |
$236.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$105.87
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Humana Medicare |
$13.55
|
| Rate for Payer: IEHP Medi-Cal |
$18.80
|
| Rate for Payer: IEHP Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$105.87
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Humana Medicare |
$13.55
|
| Rate for Payer: IEHP Medi-Cal |
$18.80
|
| Rate for Payer: IEHP Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC SOFT PALATE
|
Facility
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.86 |
| Max. Negotiated Rate |
$1,047.75 |
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$959.74
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$945.77
|
| Rate for Payer: Heritage Provider Network Senior |
$945.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.25
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
|
|
HC SOFT PALATE
|
Facility
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$1,047.75 |
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$959.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Blue Shield of California Commercial |
$867.54
|
| Rate for Payer: Blue Shield of California EPN |
$820.04
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$908.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$864.74
|
| Rate for Payer: Heritage Provider Network Senior |
$864.74
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.48
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.22
|
| Rate for Payer: Heritage Provider Network Senior |
$626.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC SOGDX 230 GCH1 81479
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914803
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$786.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$508.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$693.75
|
| Rate for Payer: Blue Shield of California Commercial |
$574.42
|
| Rate for Payer: Blue Shield of California EPN |
$542.98
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$786.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$786.25
|
| Rate for Payer: Dignity Health Senior |
$786.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$786.25
|
| Rate for Payer: Vantage Medical Group Senior |
$786.25
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
IP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$122.18 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.72
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.98
|
| Rate for Payer: Heritage Provider Network Senior |
$456.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
|
|
HC SOGDX 317 SIX1 81479
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914808
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$573.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$371.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$506.25
|
| Rate for Payer: Blue Shield of California Commercial |
$419.18
|
| Rate for Payer: Blue Shield of California EPN |
$396.22
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.75
|
| Rate for Payer: Dignity Health Senior |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.82
|
| Rate for Payer: Heritage Provider Network Senior |
$417.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$325.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.75
|
| Rate for Payer: Vantage Medical Group Senior |
$573.75
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$958.36
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$944.42
|
| Rate for Payer: Heritage Provider Network Senior |
$944.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.75
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
|
